Healthcare Provider Details

I. General information

NPI: 1164511325
Provider Name (Legal Business Name): TODD IAN COHEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S WHITE HORSE PIKE
MAGNOLIA NJ
08049-1061
US

IV. Provider business mailing address

419 DOWNS DR
CHERRY HILL NJ
08003-3414
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-9700
  • Fax:
Mailing address:
  • Phone: 856-889-9423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI01795400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17954
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS027804L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: